Approach to stridor

Noor Zehan Abdul Rahim
Sunway Medical Centre, Selangor, Malaysia

Stridor is a hallmark sign of upper airway obstruction in children, often prompting urgent evaluation. A structured, traditional approach remains foundational—beginning with detailed history-taking, physical examination, and analysis of stridor timing (inspiratory, biphasic, or expiratory) to help localise the level of obstruction. Age-specific differentials are considered, ranging from laryngomalacia and vocal cord palsy in neonates to croup or foreign body aspiration in toddlers.

Initial investigations include pulse oximetry, lateral neck and chest radiographs, and bedside flexible nasoendoscopy. Microlaryngobronchoscopy (MLB) remains the gold standard for direct airway evaluation, offering detailed assessment of both dynamic and structural abnormalities.

Recent advances in imaging now complement the traditional workup. Dynamic airway CT and cine MRI have emerged as valuable, non-invasive tools for assessing tracheomalacia, vascular compression, and other subtle airway pathologies. These modalities allow real-time evaluation of airway dynamics without immediate need for invasive procedures.

Management is guided by the severity and cause of stridor—ranging from acute stabilization in emergency settings to long-term follow-up and surgical correction for congenital or acquired anomalies. A multidisciplinary team approach, involving ENT, respiratory physicians, anaesthetists, and radiologists, is essential for safe and effective care.

This lecture provides a comprehensive overview of paediatric stridor, reaffirming traditional diagnostic methods while integrating up-to-date, evidence-based airway investigations for enhanced clinical decision-making.